Abnormal Uterine Bleeding

Abnormal Uterine Bleeding

Topic Overview

Is this topic for you?

This topic is for women who want to learn about or have been diagnosed with abnormal uterine bleeding (AUB). Abnormal uterine bleeding has several causes. If you don’t know what kind of bleeding you have, see the topicAbnormal Vaginal Bleeding.

What is abnormal uterine bleeding?

Abnormal uterine bleeding (AUB) is irregular bleeding from theuterus that is longer or heavier than usual or does not occur at your regular time. For example, you may have heavy bleeding during your period or in between periods.

Bleeding during pregnancy is a different problem. If you are pregnant and have any amount of bleeding from the vagina, be sure to tell your doctor.

What causes abnormal uterine bleeding?

Abnormal uterine bleeding has many causes. It is sometimes caused by changes in hormone levels. It can also be caused by problems such as growths in the uterus or clotting problems.

In some cases the cause of the bleeding isn’t known.

What are the symptoms?

You may have abnormal uterine bleeding if you have one or more of the following symptoms:

You get your period more often than every 21 days or farther apart than 35 days. A normal adult menstrual cycle is 21 to 35 days long. A normal teen cycle is 21 to 45 days.

Your period lasts longer than 7 days (normally 4 to 6 days).

Your bleeding is heavier than normal. If you are passing blood clots and soaking through your usual pads or tampons each hour for 2 or more hours, your bleeding is considered severe and you should call your doctor.

How is abnormal uterine bleeding diagnosed?

Before your doctor finds the cause of abnormal uterine bleeding, he or she must first make sure it’s not vaginal bleeding from pregnancy or miscarriage.

Your doctor will ask how often, how long, and how much you have been bleeding. You may also have apelvic exam, urine test, blood tests, and possibly an ultrasound. These tests will help your doctor check for other causes of your symptoms. He or she may also take a tiny sample (biopsy) of tissue from your uterus for testing.

How is it treated?

Let your doctor know if you have abnormal uterine bleeding. There are many ways to help treat it. Some are meant to return the menstrual cycle to normal. Others are used to reduce bleeding or to stop monthly periods. Each treatment works for some women but not others. Treatments include:

Hormones, such as a progestin pill or daily birth control pill (progestin and estrogen). These hormones help control the menstrual cycle and reduce bleeding and cramping.

Use of the levonorgestrelIUD, which releases a progesterone-like hormone into the uterus. This reduces bleeding while preventing pregnancy.

If you also have menstrual pain or heavy bleeding, you can take regular doses of a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen.

In some cases, doctors use watchful waiting, or a wait-and-see approach. It may be okay for a teen or for a woman nearingmenopause. Some teens have times of irregular vaginal bleeding. This usually gets better over time as hormone levels even out. Women in menopause can expect their periods to stop. They may choose to wait and see if this happens before they try other treatments.

Blood loss of more than80 mL (3 fl oz) each menstrual cycle [normally about30 mL (1 fl oz)]. If you are passing blood clots and soaking through your usual pads or tampons each hour for 2 or more hours, your bleeding is considered severe.

What Happens

Abnormal uterine bleeding often occurs before age 20 and after age 40.

Teen years. Some teens have times of irregular vaginal bleeding. This usually gets better over time as hormone levels even out and the menstrual cycle becomes more regular. If you need treatment, your doctor may give you hormones to help regulate your menstrual cycle. He or she may also prescribe medicine to reduce bleeding.

Reproductive years. Some women in their 20s and 30s have abnormal uterine bleeding. Sometimes it’s because of changes in hormone levels or growths in the uterus such as fibroids or polyps. And sometimes the reason is not known. Your treatment may depend on whether you are planning to have children.

After age 40: Perimenopausal and menopausal years. After age 40, women tend to have changing hormone levels. During this time before your period stops (perimenopause), you may not alwaysovulate. This can lead to irregular vaginal bleeding. You can expect this bleeding to go away on its own whenmenopause is complete. Your treatment options depend on your childbearing plans and how much your symptoms affect your daily life. Your doctor may recommend a wait-and-see approach, hormones, or a surgical procedure.

No matter what your age, see your doctor if you have irregular vaginal bleeding.

You prefer to wait and see if your symptoms get better on their own. If you are a teen, you can expect your cycles to even out with time. If you are nearing the age of menopause, you can expect menstrual cycles to stop sometime soon.

Talk to your doctor if you have not had a menstrual period for more than 3 months.

Who to see

Health professionals who can do an initial evaluation of a vaginal bleeding problem include:

Pap smear and cultures to check for infection or abnormal cervical cells.

Urine test to screen for infection, disease, and other signs of poor health.

Transvaginal pelvic ultrasound, to check for any abnormalities in the pelvic area. After the pelvic exam, a transvaginal ultrasound is often the next step in diagnosing a vaginal bleeding problem. If a pelvic mass is found, ultrasound results are useful for making further testing and treatment decisions.

Sonohysterogram, which uses ultrasound to monitor the movement of a salt solution (saline), which is injected into the uterus. This test may be done to look for uterinepolyps orfibroids.

Endometrial biopsy, usually for women older than 35 or who arepostmenopausal, to learn whether the lining of the uterus (endometrium) is healthy and functioning normally.

Hysteroscopy, if no cause is apparent but a problem condition is suspected; to check for and treat a suspected condition, such as uterine fibroids; or if bleeding continues despite treatment.

Early detection

Endometrial cancer risk increases with age. Also known as uterine cancer, it is most common in women over age 50, after menopause. But endometrial cancer can also develop earlier, during perimenopause or in women who have had abnormal bleeding for many years.

If you have heavy or unusual vaginal bleeding after menopause, your doctor will do tests, usually either ultrasound or endometrial biopsy, to look for cancerous cell changes.

If you are perimenopausal, have not responded to other treatment for uterine bleeding, or have things that increase your risk for endometrial cancer, your doctor may recommend an endometrial biopsy.

Treatment Overview

It’s important to let your doctor know if you have abnormal uterine bleeding. There are many ways to help treat it. Bleeding can usually be managed with medicine to reduce bleeding and/or hormone therapy to either stop or regulate menstrual periods. Surgical treatment is reserved for bleeding that can’t be controlled with medicine or hormone therapy.

Acute, severe uterine bleeding

Severe uterine bleeding is usually treated on an emergency basis with a short course of high-dose estrogen therapy. If that isn’t effective in rare cases, adilation and curettage (D&C) may be done to clear the uterus of tissue. When needed, a blood transfusion is used to quickly restore needed blood volume.

If you are treated for severe uterine bleeding, you and your doctor can then choose a treatment that is safe for the longer term.

Ongoing uterine bleeding

Your age, the cause of your condition, and any future plans for pregnancy will impact the treatment choices available to you.

If you are a teen, you can expect your periods to become more regular as your body matures. You may choose to wait and see if your periods become more regular. If you need treatment, your doctor may prescribe progestin or birth control pills to regulate your cycle.

If you are not ovulating regularly, it’s difficult to predict how long your abnormal bleeding will last until you stop having periods completely (menopause). If you need treatment, your doctor may give you hormone therapy (such as birth control pills or a hormonal IUD) to regulate your cycle. If you have no future childbearing plans and have severe symptoms, you can opt for surgical treatment to remove your uterus (hysterectomy) or to destroy the uterine lining (endometrial ablation).

If you are ovulating regularly, have abnormal bleeding, and plan to become pregnant in the future, talk to your doctor about your treatment options. Depending on the cause of your bleeding, he or she may recommend treatments such as progestin or birth control pills or a hysteroscopy to remove polyps or fibroids. If you have no future pregnancy plans, you can consider endometrial ablation or hysterectomy if other treatment doesn’t help.

Gonadotropin-releasing hormone analogues (GnRH-As) are rarely used now. These drugs reduce estrogen production, making your body think it is in menopause. This reduces or stops menstrual periods for as long as you take the medicine. After you stop taking the medicine, your symptoms will come back unless you are close to menopause. Side effects with GnRH-As are common.

A medicine called tranexamic acid (such as Lysteda) is sometimes used for women who have bleeding that is heavier than normal. This medicine is not a hormone. It prevents bleeding by helping blood to clot. Talk to your doctor to find out if this option is right for you.

Will you be starting menopause soon? If you are approaching menopause, you can expect uterine bleeding to naturally stop without treatment.

The answers to these questions will help you and your doctor select the treatment plan that is best for you.

Prevention

Sometimes hormonal changes cause abnormal uterine bleeding, so it cannot be prevented. But being overweight can affect your hormone production, which increases your risk for irregular menstrual bleeding. If you are overweight, losing weight may help prevent abnormal uterine bleeding.

Home Treatment

You can use home treatment for some problems related to abnormal uterine bleeding.

For menstrual pain and heavy bleeding, you can use anonsteroidal anti-inflammatory drug (NSAID), such as over-the-counter ibuprofen. This type of medicine lowersprostaglandins, which cause menstrual pain, and reduces bleeding during your period. An NSAID works best when you start taking it 1 to 2 days before you expect pain to start. If you don’t know when your period will start next, take your first dose of an NSAID as soon as bleeding or premenstrual pain starts. Be safe with medicines, and follow your doctor’s instructions.

Irregular menstrual bleeding can lead to low levels of iron in the blood. This condition is known asanemia. You can prevent anemia by increasing the amount of iron in your diet.

Medications

Medicines often help treat abnormal uterine bleeding, and they have fewer risks than surgical treatment. If you plan to become pregnant in the future, or if you are nearing the time when your menstrual periods will stop (menopause), you may want to try medicines first.

Goals of medicine treatment

The goal of medicine treatment for abnormal uterine bleeding is to reduce or eliminate blood loss. This can be done in one or both of the following ways:

Regulating or eliminating the menstrual cycle by changing hormonal levels

Medicine choices

There are several hormone therapies for managing abnormal uterine bleeding. These treatments help reduce bleeding and regulate the menstrual cycle:

Birth control pills (syntheticestrogen and progesterone). Daily birth control pills prevent pregnancy. They also reduce the amount of heavy menstrual bleeding by about half.footnote 2 In other words, when you take birth control pills, your menstrual bleeding can be half as heavy as it was before you took the pills. But when you stop taking the pills, irregular bleeding or perimenopausal symptoms may return.

Progestin pills (syntheticprogesterone). In some women, progestins can control endometrial growth and bleeding. You usually take progestins 10 to 12 days every month.

Thelevonorgestrel intrauterine device (IUD). A doctor inserts this birth control device into your uterus through your vagina. It stays in your body for up to 5 years and releases levonorgestrel, a form of progesterone, into the uterus.

Estrogen. In some severe or urgent cases, estrogen may be used to reduce bleeding.

Hormone suppressors such as gonadotropin-releasing hormone analogues (GnRH-As). GnRH-As are rarely used. These drugs reduce estrogen production, making your body think it is in menopause. This reduces or stops menstrual periods for as long as you take the medicine. Side effects with GnRH-As are common.

A medicine called tranexamic acid (such as Lysteda) is sometimes used for women who have bleeding that is heavier than normal. This medicine is not a hormone. It prevents bleeding by helping blood to clot. Talk to your doctor to find out if this option is right for you.

What to think about

Intravenous estrogen therapy is typically used when severe blood loss must be quickly stopped.

Surgery

Surgery is generally reserved for treating abnormal uterine bleeding that can’t be controlled with medicine.

Surgery choices

The following procedures are used to treat abnormal uterine bleeding.

Hysteroscopy can be used to diagnose and treat abnormal uterine bleeding at the same time. A lighted viewing instrument called a hysteroscope is inserted through the vagina and cervix and into the uterus. When areas of bleeding are located,biopsies can be taken and then the areas of bleeding can be treated with either a laser beam or electric current (electrocautery).

Hysterectomy is the removal of the uterus. It may be done when a sample of the uterine lining (endometrial biopsy) shows abnormal cell changes or cancer, when uterine bleeding is uncontrollable, or when the cause of chronic bleeding cannot be found and treated. A hysterectomy is a major surgery with risks of complications. Recovery from surgery can take 4 to 8 weeks, depending on the type of hysterectomy done. If the ovaries are also removed, you may need to take long-termestrogen therapy after surgery.

Endometrial ablation is a minimally invasive alternative to hysterectomy when other medical treatments fail or when you or your doctor have reasons for not using other treatments. Endometrial ablation scars the uterine lining, so it is not a treatment option if you are planning to become pregnant.

What to think about

Hysteroscopy may be done to rule out serious uterine conditions:

Before long-term treatment with medicines or surgical treatment for abnormal uterine bleeding.

When uterine bleeding has continued despite nonsurgical treatment.

Hysterectomy may be used as surgical treatment for abnormal uterine bleeding when:

Abnormal uterine bleeding does not respond to medicine or other treatment.

Childbearing is completed and you do not wish to try treatment with medicine.

Symptoms of abnormal uterine bleeding outweigh the risks and discomforts of surgery.

Regrowth of the endometrium may occur after you have endometrial ablation.

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